Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Aggressive treatment of patients with severe head injury increases the chance for survival and good functional outcome in most cases. To prevent irreversible cerebral lesions, the key point of treatment is the management of intracranial hypertension caused by intracranial hematomas, brain edema and impaired circulation of cerebrospinal fluid (CSF). Therapeutic standards are surgery of traumatic hematoma, osmotherapy and mild hyperventilation for brain edema, and CSF drainage. In highly elevated intracranial pressure (ICP) administration of barbiturates and forced hyperventilation can be considered.
-
In the last two decades our understanding of the pathophysiology of severe head injury has significantly increased. It has become evident that secondary neuronal damage may occur and should be prevented. It is ischemia, similar to that seen with stroke and aneurysmal subarachnoid hemorrhage, that causes secondary brain damage. ⋯ Moreover, there are some new pharmacological concepts for changing the threshold for ischemia in brain tissue. At the present time, however, valid data concerning clinical use are still not available. Therefore, mild hyperventilation and sedation during the initial post-traumatic phase and lowering of intracranial pressure by osmotherapeutics remain the most important treatment modalities, as they were 20 years ago.
-
ORIF management of unstable trochanteric fractures of type A3 of the A0 classification is difficult because of lateral dislocation of the proximal fractured segments, particularly when only the sliding hip-screw is used for fixation. A connectable butt-press plate was recently developed in order to prevent this type of dislocation. We review the results with this fixation technique in 22 elderly patients with an average age of 76 years who presented with highly unstable trochanteric fracture of the A3 type. ⋯ No pseudarthrosis, osteitis or rotational malalignment was noted. Five of the surviving patients had a lower mobility score after fracture healing as compared to the status before the fracture was sustained. On the basis of this review, we recommend the use of this new connectable buttress plate with sliding hip screws because it provides sufficient fixation of highly unstable fractures of type A3.
-
Head traumas frequently occur in polytrauma patients but are also found as isolated injuries. In our hospital trauma center without a neurosurgical department, in a 21-month period, 489 patients with head/brain trauma were treated. This represents 6.5% of all patients treated in the trauma and reconstructive surgery clinic. ⋯ In patients with intracerebral bleeding, bleeding in the dorsal fossa, injury of brain nerves, carotid artery or sinus cavernosus injuries, frontobasal injuries with liquor fistula or pneumonencephalon, transfer of the patients to specialized neurosurgical centers is indicated. With this selection, we obtained the same results in a trauma center without a neurosurgical department as reported in the literature. This avoids overloading neurosurgical centers with head/brain injury patients.
-
Open reduction and internal fixation of intraarticular calcaneus fractures have been increasingly emphasized in recent years. Operation of most of these fractures is via an extended lateral approach. Different implants are used to stabilize the often complex fractures. ⋯ Because the design is based on the anatomy of the calcaneus, all types of fractures can be treated. The plate has a large number of holes to accommodate screw fixation. Our results in 36 cases were comparable to those of other series using open reduction and internal fixation with plates and the demands on the plate were fulfilled.